Take two minutes... Tell us what you think

Have you or your family / friends used our services?

We are keen to hear your views if you or your family/friends have recently used our services. Please complete this short survey and tell us what you think.

Please note that all responses will be treated anonymously and will be used by the Patient Experience Steering Group to identify good practice and areas for improvement.

Thank you

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* 1. Was your experience as a:

Patient

Friend / family of a patient

Main carer of a patient

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* 2. Where did your experience take place?

Royal Victoria Infirmary (RVI)

Freeman

Campus for Ageing and Vitality (CAV)

Dental Hospital

Centre for Life

Community

Other (please specify)

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* 3. Which Directorate was your experience in?

Accident and Emergency

Cancer Services

Cardiothoracic Services

Childrens Services

Community Services

Dental

ENT, Plastics, Ophthamology and Dermatology

Genetics

Internal Medicine

Laboratory Medicine

Musculoskeletal Services

Neurosciences

Peri-operative and critical care

Radiology

Renal Services

Surgical Services

Urology

Womens Services

Estates and Facilities

Other (please specify)

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* 4. How would you rate the following:

	Excellent	Good	Fair	Poor	N/A
The attitude of staff	The attitude of staff Excellent	The attitude of staff Good	The attitude of staff Fair	The attitude of staff Poor	The attitude of staff N/A
Communication with the patient	Communication with the patient Excellent	Communication with the patient Good	Communication with the patient Fair	Communication with the patient Poor	Communication with the patient N/A
Involvement of the patient in making decisions about their care and treatment	Involvement of the patient in making decisions about their care and treatment Excellent	Involvement of the patient in making decisions about their care and treatment Good	Involvement of the patient in making decisions about their care and treatment Fair	Involvement of the patient in making decisions about their care and treatment Poor	Involvement of the patient in making decisions about their care and treatment N/A
Arrangements for discharge	Arrangements for discharge Excellent	Arrangements for discharge Good	Arrangements for discharge Fair	Arrangements for discharge Poor	Arrangements for discharge N/A
The quality of the food	The quality of the food Excellent	The quality of the food Good	The quality of the food Fair	The quality of the food Poor	The quality of the food N/A

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* 5. Was there anything particularly good about your experience?

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* 6. Was there anything that could be improved?

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* 7. If you are willing to be contacted for further details or to take part in a focus group around potential areas for improvement, please provide your contact details in the space below